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Report File
Date Issued
Submitting OIG
Department of Defense OIG
Agencies Reviewed/Investigated
Department of Defense
Report Type
Audit
Agency Wide
Yes
Number of Recommendations
5
Questioned Costs
$0
Funds for Better Use
$0
Report updated under NDAA 5274
No

Open Recommendations

This report has 5 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
D-2025-0070-D000AW-0001-0001.a No $0 $0

Rec. 1.a: The DoD OIG recommended that the Director, Defense Health Agency, modify the managed care support contracts or TRICARE guidance to explicitly require the TRICARE managed care support contractors to use the Defense Health Agency-established age limits list for all claims.

D-2025-0070-D000AW-0001-0001.b No $0 $0

Rec. 1.b: The DoD OIG recommended that the Director, Defense Health Agency perform a one-time review to ensure that all existing age limits within the Defense Health Agency-established age limits list match age limits established by the American Medical Association and Centers for Medicare and Medicaid Services, where applicable, and revise the age limits accordingly.

D-2025-0070-D000AW-0001-0001.c No $1,008,403 $0

Rec. 1.c: The DoD OIG recommended that the Director, Defense Health Agency perform a review of the $1 million in payments that the managed care support contractors paid for health care services provided from FYs 2019 to 2023 that did not meet the Defense Health Agency-established age limits list, and recoup where applicable. As part of the review, assess the managed care support contractors' medical review process when determining whether the managed care support contractors paid for services and items in compliance with the Defense Health Agency-established age limits list.

D-2025-0070-D000AW-0001-0001.d No $26,297,658 $0

Rec. 1.d: The DoD OIG recommended that the Director, Defense Health Agency perform a review of the $26.3 million in questioned costs that the managed care support contractors paid for pediatric enteral formula provided from FYs 2019 to 2023 in which the Defense Health Agency-established aged limits list did not meet the pediatric description as defined by the Centers for Medicare and Medicaid Services and age limits identified within product labeling and medical literature. Initiate recoupment of the payments if the Defense Health Agency determines that the managed care support contractors should not have paid for the pediatric enteral formula.

D-2025-0070-D000AW-0001-0001.e No $0 $0

Rec. 1.e: The DoD OIG recommended that the Director, Defense Health Agency revise Defense Health Agency policy to require the Defense Health Agency to perform an annual review of high-risk payments in which managed care support contractors paid claims for health care services and items provided in FY 2024 and future years that did not meet the Defense Health Agency-established age limits list requirements.

Department of Defense OIG

United States